| NPI | 1467563114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRANCES CLARK Owner 219-345-5151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71000776A) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |